Noebauer-Huhmann Iris-M, Koenig Felix R M, Chiari Catharina, Schmaranzer Florian
Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich.
Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Wien, Österreich.
Radiologie (Heidelb). 2023 Oct;63(10):749-757. doi: 10.1007/s00117-023-01197-6. Epub 2023 Sep 12.
Femoroacetabular impingement syndrome (FAIS) is caused by a repetitive mechanical conflict between the acetabulum and the proximal femur, occurring in flexion and internal rotation. In cam impingement, bony prominences of the femoral head-neck junction induce chondrolabral damage. The acetabular type of FAIS, termed pincer FAIS, may be either due to focal or global retroversion and/or acetabular overcoverage. Combinations of cam and pincer morphology are common. Pathological femoral torsion may aggravate or decrease the mechanical conflict in FAI but can also occur in isolation. Of note, a high percentage of adolescents with FAI-like shape changes remain asymptomatic. The diagnosis of FAIS is therefore made clinically, whereas imaging reveals the underlying morphology. X‑rays in two planes remain the primary imaging modality, the exact evaluation of the osseous deformities of the femur and chondrolabral damage is assessed by magnetic resonance imaging (MRI). Acetabular coverage and version are primarily assessed on radiographs. Evaluation of the entire circumference of the proximal femur warrants MRI which is further used in the assessment of chondrolabral lesions, and also bone marrow and adjacent soft tissue abnormalities. The MRI protocol should routinely include measurements of femoral torsion. Fluid-sensitive sequences should be acquired to rule out degenerative or inflammatory extra-articular changes.
股骨髋臼撞击综合征(FAIS)是由髋臼与股骨近端之间反复的机械性冲突引起的,发生于屈曲和内旋时。在凸轮撞击中,股骨头-颈交界处的骨突起会导致盂唇软骨损伤。FAIS的髋臼型,即钳夹型FAIS,可能是由于局部或整体髋臼后倾和/或髋臼覆盖过度所致。凸轮和钳夹形态的组合很常见。病理性股骨扭转可能会加重或减轻FAI中的机械性冲突,但也可能单独出现。值得注意的是,有相当比例的青少年虽然存在类似FAI的形态改变,但仍无症状。因此,FAIS的诊断是基于临床做出的,而影像学检查则揭示其潜在的形态。两个平面的X线片仍是主要的影像学检查方式,股骨骨畸形和盂唇软骨损伤的确切评估需通过磁共振成像(MRI)进行。髋臼覆盖和髋臼方向主要通过X线片评估。对股骨近端整个圆周的评估需要MRI,MRI还可用于评估盂唇软骨损伤以及骨髓和相邻软组织异常。MRI检查方案应常规包括股骨扭转测量。应采集对液体敏感的序列以排除关节外的退行性或炎性改变。